Aspirus Health Job Shadow Application

Job Shadow Application
Aspirus Health job shadows are observation‑only experiences that allow participants to watch healthcare professionals perform their daily responsibilities. Hands‑on involvement in work tasks is not permitted. Applications are reviewed for accuracy and completeness, and incomplete submissions will not be considered. Submitting an application does not guarantee placement.
APPLICANT INFORMATION
Applicant legal name*

First NameLast Name
Applicant date of birth*

MonthDayYear
Must be at least 16 years old to shadow.
Applicant age*
Must be at least 16 years old to shadow.
School or organization, if applicable
Applicant school or organization email, if applicable
example@example.com
Applicant personal email*
example@example.com
Applicant phone number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant home address*

Street Address

Street Address Line 2

CityState

Zip Code
Emergency contact name*

First NameLast Name
Emergency contact phone number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
Please specify your work location and department.
Please specify your intended shadowing location and department.
It is my responsibility to arrange the date, time, and details of the shadowing activity in collaboration with my leader. By checking this box, I acknowledge that I am responsible for coordinating with my leadership to schedule my shadowing experience.

SHADOWING REQUEST DETAILS
Shadow duration*
Note: Additional documentation is required for the extended shadow option.
Total shadowing hours being requested for this year
Note: Requested hours are not guaranteed and are subject to department availability. For reporting purposes, a year is defined as September 1 - August 31.
Total shadowing hours being requested for this year
Note: Requested hours are not guaranteed and are subject to department availability. For reporting purposes, a year is defined as September 1 - August 31.
Former Aspirus employeePrevious student/shadowing experience at Aspirus within the last year, with the year being defined as September 1 - August 31.
Reason for shadow request*
Choose one option above.
If other, please specify reason for request.
Degree or career of interest *
If other, please specify degree or career of interest.
If you are interested in a specific department for the shadowing experience, please indicate one department below.
Optional
Location Requested*
If requesting a shadowing experience in a clinic setting, please enter the name of the clinic.
For assistance finding a clinic name, please visit https://search.aspirus.org/locations
Preferred person to shadow, if known

First NameLast Name
Earliest date applicant is available to shadow*

MonthDayYear
NOTE: Date must be at least 4 weeks in the future to allow time for processing the request.
Latest date applicant is available to shadow*

MonthDayYear
NOTE: Date must be at least 7 days after earliest date applicant is available to shadow.
Preferred days of the week applicant is available to shadow*
Applicants under 18 who are shadowing in Michigan must obtain parent/guardian permission to participate. Parent/guardian: Please sign below to indicate that you are granting permission to participate and that you acknowledge that the applicant may be contacted by Aspirus Health for recruiting purposes.
Parent/Guardian Signature

Clear

ONBOARDING DOCUMENTS REVIEW

Please open, save, and review all the documents below as a condition of your placement with Aspirus Health.
Code of Conduct

Compliance

Confidentiality Policy

Drug and Alcohol-Free Workplace Policy

Infection Prevention

Regulatory Review

Harassment & Discrimination Free Workplace Policy

Social Media/Networking Policy

Use of Personal/Company Provided Electronic Device Policy
I certify that I have reviewed all Aspirus Health shadow applicant onboarding documents linked above. By checking this box, I certify that I am responsible for understanding the information contained in all linked documents. Falsifying this statement or failure to comply with Aspirus Health policies will result in disciplinary action that may include expulsion from the facility for the remainder of the shadowing experience.

HEALTH HISTORY

Required for all standard and extended shadow experiences.
If I have any allergies that may impact my shadowing experience, I will inform the person I am shadowing so they are aware of any potential allergic reactions. By checking this box, I acknowledge that I have read and understand this requirement.
If I may be pregnant, I will inform the person I am shadowing prior to the start of my experience, as exposure to certain procedures could be harmful to an unborn child. By checking this box, I acknowledge that I have read and understand this requirement.
I understand that I am conducting a shadow experience in a healthcare facility and need to maintain infection control standards. I will not report to my shadow experience if I have any signs and symptoms of a contagious illness, such as fever, vomiting, diarrhea, or open skin lesions. I will be responsible for informing the person I am shadowing if I am unable to attend. By checking this box, I acknowledge that I have read and understand this requirement.
I understand that it is strongly recommended that I receive annual influenza vaccination and the current seasonal COVID-19 vaccination to help protect patients, staff, and myself by reducing the risk of infectious disease transmission in healthcare settings. I understand that flu season varies each year but generally begins on November 1 and ends sometime after March 31. By checking this box, I acknowledge this recommendation. If I choose to opt out of the annual influenza vaccination, I agree to inform the person I am shadowing, and I will wear a surgical mask for the entirety of my shadowing experience if it takes place during flu season. Opting out of the COVID-19 vaccination does not require wearing a surgical mask.
Influenza vaccination status*
Choose the option that best describes your annual Influenza vaccination status for this year.
COVID-19 vaccination status*
Choose the option that best describes your COVID-19 vaccination status for this year.
Upload proof of Influenza and/or COVID-19 vaccination, if applicable

NOTE: All uploaded files must be official medical records and include the applicant's name and date of birth. Handwritten documentation created by the applicant or the applicant's parent/guardian will not be accepted.
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Background Study Upload

Applicants who wish to complete more than 8 hours of shadowing in a year (September 1–August 31) must submit proof of a caregiver background study. If you do not currently have background study results to upload, please use the appropriate link below to complete one. Return to this page when your results are available and ready to upload. Any questions about the background study process should be directed to the resources linked below.
MI Background Study

MN Background Study

WI Background Study
Upload Proof of Current Background Study*

Cancelof

By submitting this application, I authorize the Aspirus Health system to use my contact information for recruiting purposes. In checking this box, I confirm that I have read and understand this statement.

Prior to clicking Submit, please verify that your application is accurate and complete.
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Job Shadow Application

APPLICANT INFORMATION

SHADOWING REQUEST DETAILS

ONBOARDING DOCUMENTS REVIEW

HEALTH HISTORY

IMMUNIZATION INFORMATION

TUBERCULOSIS (TB) SYMPTOM QUESTIONNAIRE AND RISK ASSESSMENT

Background Study Upload

Prior to clicking Submit, please verify that your application is accurate and complete.